Skin Tears in the Elderly:
Causes, Prevention, and Management
Skin tears are extremely common wounds in the elderly. A skin tear involves the full or partial separation of the skin’s layers.[1]
They are acute wounds that are caused by mechanical trauma. This includes blunt force, a fall, damage from equipment or the removal of a strong adhesive dressing. They typically occur on the extremities of the body (i.e., hands, arms, and lower limbs). This is because the skin in these areas is not only thinner, but also more prone to external injury.[2]
The pain and discomfort caused by skin tears can have an extremely negative impact on an elderly person’s life.
Despite being common in older people, skin tears are often misidentified and underreported, which means that they are frequently mismanaged. Without proper management, the risk of physical distress and infection increases significantly.[3]
Why are elderly people more at risk of skin tears?
The skin is the largest organ in the body. It serves as the initial line of defence against external dangers that can harm the body’s internal organs and tissues.[4]
The structural and functional changes that the skin undergoes as we age affect its elasticity, strength and appearance:
• Loss of collagen and elastin
• Blood vessel walls become thinner
• Reduced blood supply to the extremities
• Contraction of the dermis
• Sweat and sebaceous glands become less efficient
• Exposure to UVA and UVB rays [5]
In addition to the natural consequences of ageing, other factors can compromise the skin’s integrity:
• Taking certain medications that can thin the skin (i.e., corticosteroids)
• Comorbid conditions (i.e., cancer and diabetes)
• Undergoing certain medical treatments (i.e., chemotherapy)[6]
It is important to note that skin tears also affect newborns, especially those born prematurely. This is because, just like the elderly, they tend to have frail and fragile skin.
The risk of mechanical trauma is even higher in elderly people with impaired mobility. This is because they may require more assistance with daily activities such as washing, dressing, and walking.
The use of equipment, particularly wheelchairs, can also increase the risk of skin tears. This is generally due to poor handling and blunt trauma.[7]
How to prevent skin tears in the elderly?
Two of the most important aspects of skin tear prevention are identifying elderly people at risk of skin tears, as well as making environmental changes to limit external risk factors.
A physical assessment should be conducted to identify elderly people that are vulnerable to skin-related trauma. There are multiple factors that should be considered in this assessment:
• Skin problems (i.e., history of skin tears)
• Underlying diseases
• Mobility
• Visual impairment
• Cognitive impairment
• Sex (skin tears are more common in females)
• Poor nutrition and hydration
• Medications [8]
Although these factors mean that skin tears in the elderly are not entirely preventable, steps can be taken to maintain skin integrity:
• Improve nutrition – When people age, they can sometimes develop food sensitivities and conditions that affect digestion. They may also experience a loss of appetite. It is important to tailor an elderly person’s diet to fit their needs and ensure it contains enough nutrients to support skin health.
• Encourage hydration – Provide additional fluids between meals and avoid highly caffeinated beverages. This combination will help to keep the skin hydrated.
• Limit excess bathing – Bathing can remove the skin’s natural oils, which can worsen any dryness caused by ageing. Using a pH-balanced and soapless cleanser will reduce the oil-stripping effects of bathing.
• Apply moisturiser – Use a moisturiser twice a day, particularly on the hands and legs. This can help to hydrate dry, ageing skin.[9]
Making small environmental changes can help to create a safer environment that minimises the risk of skin tears:
• Adopt good equipment handling techniques
• Pad sharp furniture edges to minimise impact
• Avoid long nails and jewellery as they can lead to scratches and pinches
• Wear long sleeves and trousers to protect the arms and legs from skin damage
• Move small rugs and other trip hazards
• Improve lighting to prevent people bumping into furniture and objects
How to manage skin tears in the elderly?
Following skin tear best practice is the key to achieving good patient outcomes.
1) Cleanse the skin tear with sterile water or saline solution.
2) Where possible, gently unfold the skin flap and bring the edges as close together as possible.
3) Select a dressing that is appropriate for the type of skin tear. The primary dressing should not have a strong adhesive. It is preferable that the dressing be a soft silicone wound contact layer that can stay in place for several days. This will enable a healthcare professional to monitor the wound without disturbing it.
Whilst it is possible to treat small skin tears at home, it is recommended that people visit a healthcare professional to prevent the wound from worsening.
References:
- Klapper, Andrew, Moradian. A Novel Way to Treat Skin Tears. International Wound Journal 2015; 12(2): 283
- Ewart, June. Caring for People with Skin Tears. Wound Essentials 2016; 11(1): 3
- LeBlanc, Kimberly, et al. Best Practice Recommendations for the Prevention and Management of Skin Tears in Aged Skin. Wounds International 2008; (1): 8
- Ewart, June. Caring for People with Skin Tears. Wound Essentials 2016; 11(1): 3
- LeBlanc, Kimberly, et al. Best Practice Recommendations for the Prevention and Management of Skin Tears in Aged Skin. Wounds International 2008; (1): 4
- Holmes, Regina F., et al. Skin Tears: Care and Management of the Older at Home 2013. Home Healthcare Nurse 2013; 31 (2): 90-101
- LeBlanc, Kimberly, et al. Best Practice Recommendations for the Prevention and Management of Skin Tears in Aged Skin. Wounds International 2008; (1): 5
- Holmes, Regina F., et al. Skin Tears: Care and Management of the Older at Home 2013. Home Healthcare Nurse 2013; 31 (2): 90-101
- Ibid: 90-101
Useful videos:
How to apply and remove dressings for skin tears
What are the most common locations for skin tears?
ISTAP skin classification
Useful articles:
What are skin tears? – Download this article
A guide to skin tear management best practice
A breakdown of the key benefits of silicone dressings for skin tears
Disclaimer:
Please note that while every effort is made to ensure the accuracy of the content presented, it is purely for educational purposes only and is not a substitute for professional medical advice.